Questions and Answers about Technicians in the Long-Term Care Pharmacy Setting

What is a Long-Term Care Pharmacy?

Long-term care (LTC) pharmacies serve the residents of nursing homes, assisted-care facilities, extended-care facilities, and/or retirement homes. Usually these are “closed-door” pharmacies, meaning that someone cannot walk in and get a prescription filled like they could at a community retail pharmacy.

How does a LTC pharmacy handle their billing, and how is it similar to how the retail pharmacy setting handles their billing?

A LTC pharmacy may bill the residents/nursing home facility on a pre-consumption basis. What this means is that the resident and their insurance company (or in some cases, the facility, for house stock items) is billed for the medication before it is dispensed to the facility. This is typically the same as how a community/chain/supermarket/independent retail pharmacy gets bills. A retail pharmacy bills on a pre-consumption basis. The patient pays for the medication before they consume it.

How often does a LTC pharmacy fill a residents’ medication and how much medication is dispensed?

Some LTC pharmacies fill for either a 14-day supply or a 30-day supply of maintenence medications. These are dispensed on "bingo" cards or in vials, depending on the facilities' preference.

Bingo cards are sealed and labeled cards, which have a foil backing.

The foil may have the name of the medication (either the brand name if the brand medication is dispensed, or the generic name if that is dispensed), the expiration date (either 1 year from the date of dispensing or sooner, if the manufacturer expiration date on the stock bottle is less than one year), the lot number from the original stock bottle, and the initials of the pharmacy tech who printed the foil.

Nurses can press the medication out of the card through the foil, and administer the resident's medication.

As long as the nursing home residents' medication is approved to be dispensed through the residents' insurance coverage, (for example, not a Prior Authorization, a Refill Too Soon, or other perscription insurance rejection) it will be dispensed according to the insurances' paramaters. What I mean by this, is that some insurance companies allow for a 14-day supply for most meds, and others require no more than a 30-day supply.

Most LTC residents are only allowed a 14-day supply of brand-name medication through their insurance.

What are “E-Kits”?

Techs employed by a LTC pharmacy may also update an “E-Kit” or an Emergency Kit for each facility.

These E-Kits were stocked with a 4-10 day supply of the most common medications each facility may use. The contents of each kit are determined by the managment at the nursing facility, with input from the pharmacy based on data from each facilities medication past and/or expected usage.

Nurses at each facility could take from the E-Kit if a new medication was prescribed and the patient needed to start taking it right away.

Before or after taking from the E-Kit, the nursing home staff would fax the medication orders to the pharmacy. The pharmacy would then dispense the new medication and it would be delivered on the next scheduled delivery.

Normal mantenince federal legend and OTC medications can be included in a facilities E-Kit.

Narcotic E-Kits have some of the most typically prescribed CII-CIV medications for the facility. In this case, a valid, signed and dated controlled substance prescription must be faxed to the facility and verified by a Pharmacist before access is given to the nurse for the prescription. The dispensed quantity that is taken from the E-Kit is substracted from the total amount of the rx and the remainder is dispensed and shipped to the facility on the next scheduled delivery.

Warfarin E-Kits have... you guessed it... warfarin in them. These kits can be accessed when it is necessary to quickly start the patient/resident when their Coumadin dose is changed (based on very recent PT/INR testing) and they need to begin therapy before the next pharmacy's delivery.

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